Friday, 18 February 2011

What is the NHS?

Close to where I live sits a cottage hospital. I have no idea what services it provides, how many people use it or how much it costs. Nor I suspect does anyone else. Regardless, I am quite sure that were an attempt made to close it the whole community would be ‘up in arms’, and before asking any of these questions. Similarly, it reminds me of a discussion I had many years ago with a friend who opined that nurses deserved ‘far more’ than they were getting paid, without even knowing how much they were getting paid. I didn’t either, but you’d have thought one statement would be predicated by the other.

That’s the thing about the National Health Service, it seems to exist in a logic-free vacuum; our relation to the institution is entirely emotional and our love measured in how many hospitals we build to house the 1.7 million people in its service. As the NHS website tells us:

Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.

They’re so proud of this it’s stated before the rather more relevant figure of how many patients they treat. It does at least explain the reaction of various Guardianistas to GP commissioning, where one concern would seem to be that GPs may on occasion choose private service providers because they’re… er… cheaper. This is apparently a bad thing; why, the next thing you know they’ll be closing state-funded hospitals in favour of privately run alternatives, and then how will we show our love?

I’m not for one instant suggesting the NHS should morph into a commission only service, we need an element of state provision to keep the private sector honest, but regardless of the provider, to the patient the service remains free - albeit paid for through tax. What kind of hospital he or she ends up in is irrelevant, all we should really care about is the cost. The cheaper it is, the more we can treat; now remind me, just who is the NHS for?